Fabrizia Lattanzio1, Andrea Corsonello2, Alberto Montesanto3, Angela M Abbatecola2, Danilo Lofaro4, Giuseppe Passarino3, Sergio Fusco2, Francesco Corica5, Claudio Pedone6, Marcello Maggio7, Stefano Volpato8, Raffaele Antonelli Incalzi6. 1. Italian National Research Center on Aging (INRCA), Scientific Direction, Ancona, Italy. 2. Unit of Geriatric Pharmacoepidemiology, Research Hospital of Cosenza, Italian National Research Center on Aging (INRCA), Italy. 3. Department of Cell Biology, University of Calabria, Arcavacata di Rende, Italy. 4. DIMEG, University of Calabria, Arcavacata di Rende, Italy. 5. Unit of Geriatric Medicine, Department of Internal Medicine, University of Messina, Messina, Italy. 6. Chair of Geriatric Medicine, University Campus BioMedico, Rome, Italy. 7. Department of Clinical and Experimental Medicine, Geriatric Clinic, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Italy. 8. Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology and Geriatrics, University of Ferrara, Italy.
Abstract
BACKGROUNDS: Chronic kidney disease (CKD), anemia, and mobility limitation are important predictors of mortality. We aimed at investigating the interactions between estimated glomerular filtration rate (eGFR), anemia, and physical performance on 1-year mortality in older patients discharged from acute care hospitals. METHODS: Four hundred and eighty seven patients enrolled in a multicenter, prospective observational study were included in the analysis. eGFR was estimated by the Berlin Initiative Study 1 equation. Anemia was defined on the basis of hemoglobin values. Mobility limitation was rated by the Short Physical Performance Battery (SPPB). Covariates included demographics, nutritional status, cognitive performance, and comorbidity. The outcome of the study was mortality over 1-year follow-up. Interactions among study variables were investigated by survival tree analysis. RESULTS: eGFR < 30 mL/min/1.73 m(2), anemia, and SPPB = 0-4 were significantly associated with mortality, as were hypoalbuminemia and cognitive impairment. Survival tree analysis showed that compared to patients with SPPB ≥ 4 and eGFR ≥ 46.7 mL/min/1.73 m(2) (ie, patients with the least mortality), patients with SPPB < 4 and hemoglobin < 12.2 g/dL had the highest risk of mortality [hazard ratio (HR) = 28.9, 95%CI 10.3-81.2]. Patients with SPPB ≥ 4 and eGFR < 46.7 mL/min/1.73 m(2) and those with SPPB > 4, hemoglobin ≥ 12.2g/dL, and eGFR ≥ 58.6 mL/min/1.73 m(2) had intermediate risk (HR = 6.58, 95%CI = 2.15-20.2, and HR = 15.11, 95%CI=4.42-51.7, respectively). Having SPPB < 4, hemoglobin ≥ 12.2 g/dL, and eGFR<58.6 mL/min/l.73 m(2) was not significantly associated with increased mortality (HR = 2.95, 95%CI = 0.74-11.8). CONCLUSIONS: Interactions among eGFR, anemia, and mobility limitation define different profiles of risk in older patients discharged from acute care hospitals, which deserve to be considered to identify patients needing special care and careful follow-up after discharge.
BACKGROUNDS: Chronic kidney disease (CKD), anemia, and mobility limitation are important predictors of mortality. We aimed at investigating the interactions between estimated glomerular filtration rate (eGFR), anemia, and physical performance on 1-year mortality in older patients discharged from acute care hospitals. METHODS: Four hundred and eighty seven patients enrolled in a multicenter, prospective observational study were included in the analysis. eGFR was estimated by the Berlin Initiative Study 1 equation. Anemia was defined on the basis of hemoglobin values. Mobility limitation was rated by the Short Physical Performance Battery (SPPB). Covariates included demographics, nutritional status, cognitive performance, and comorbidity. The outcome of the study was mortality over 1-year follow-up. Interactions among study variables were investigated by survival tree analysis. RESULTS: eGFR < 30 mL/min/1.73 m(2), anemia, and SPPB = 0-4 were significantly associated with mortality, as were hypoalbuminemia and cognitive impairment. Survival tree analysis showed that compared to patients with SPPB ≥ 4 and eGFR ≥ 46.7 mL/min/1.73 m(2) (ie, patients with the least mortality), patients with SPPB < 4 and hemoglobin < 12.2 g/dL had the highest risk of mortality [hazard ratio (HR) = 28.9, 95%CI 10.3-81.2]. Patients with SPPB ≥ 4 and eGFR < 46.7 mL/min/1.73 m(2) and those with SPPB > 4, hemoglobin ≥ 12.2g/dL, and eGFR ≥ 58.6 mL/min/1.73 m(2) had intermediate risk (HR = 6.58, 95%CI = 2.15-20.2, and HR = 15.11, 95%CI=4.42-51.7, respectively). Having SPPB < 4, hemoglobin ≥ 12.2 g/dL, and eGFR<58.6 mL/min/l.73 m(2) was not significantly associated with increased mortality (HR = 2.95, 95%CI = 0.74-11.8). CONCLUSIONS: Interactions among eGFR, anemia, and mobility limitation define different profiles of risk in older patients discharged from acute care hospitals, which deserve to be considered to identify patients needing special care and careful follow-up after discharge.
Authors: Heather J MacKinnon; Thomas J Wilkinson; Amy L Clarke; Douglas W Gould; Thomas F O'Sullivan; Soteris Xenophontos; Emma L Watson; Sally J Singh; Alice C Smith Journal: Ther Adv Chronic Dis Date: 2018-07-04 Impact factor: 5.091
Authors: Andrea Corsonello; Lisanne Tap; Regina Roller-Wirnsberger; Gerhard Wirnsberger; Carmine Zoccali; Tomasz Kostka; Agnieszka Guligowska; Francesco Mattace-Raso; Pedro Gil; Lara Guardado Fuentes; Itshak Meltzer; Ilan Yehoshua; Francesc Formiga-Perez; Rafael Moreno-González; Christian Weingart; Ellen Freiberger; Johan Ärnlöv; Axel C Carlsson; Silvia Bustacchini; Fabrizia Lattanzio Journal: BMC Nephrol Date: 2018-10-11 Impact factor: 2.388
Authors: Andrea Corsonello; Regina Roller-Wirnsberger; Gerhard Wirnsberger; Johan Ärnlöv; Axel C Carlsson; Lisanne Tap; Francesco Mattace-Raso; Francesc Formiga; Rafael Moreno-Gonzalez; Christian Weingart; Cornel Sieber; Tomasz Kostka; Agnieszka Guligowska; Pedro Gil; Sara Lainez Martinez; Rada Artzi-Medvedik; Itshak Melzer; Fabrizia Lattanzio Journal: J Clin Med Date: 2020-01-21 Impact factor: 4.241
Authors: Rada Artzi-Medvedik; Robert Kob; Paolo Fabbietti; Fabrizia Lattanzio; Andrea Corsonello; Yehudit Melzer; Regina Roller-Wirnsberger; Gerhard Wirnsberger; Francesco Mattace-Raso; Lisanne Tap; Pedro Gil; Sara Lainez Martinez; Francesc Formiga; Rafael Moreno-González; Tomasz Kostka; Agnieszka Guligowska; Johan Ärnlöv; Axel C Carlsson; Ellen Freiberger; Itshak Melzer Journal: BMC Geriatr Date: 2020-10-02 Impact factor: 3.921